10th October 2022 is the World Mental Health Day. The theme is ‘Make mental health and wellbeing for all a global priority’.
1 in 5 people in the flood affected districts most likely are in need of mental healthcare. With a severe dearth of specialists, how can Pakistan respond to this crisis?
Role of Mental Healthcare in the Communities Affected by Disaster
Experiencing a natural disaster can be extremely stressful. Even when the immediate danger has passed, the impact lingers for a long time. People may feel grief or anger over the damage or loss, fear or hopelessness when thinking about rebuilding their lives, or they may simply feel overwhelmed and not know how to begin restoring their lives and livelihoods.
And yet, the mental trauma inflicted by disasters often goes unrecognized. According to the World Health Organization, some 20-40% of the affected populations experience mild psychological distress, 30-50% suffer from moderate to severe psychological distress, while a minority develop new and debilitating mental disorders. Evidence shows that timely provision of mental health and psychosocial support reduces the chances of full-blown mental and psychological illnesses.
To mitigate consequences of the disaster in vulnerable populations, it is important to provide emotional support during the acute period following a disaster. Such support enables affectees to express and understand their reactions caused by the disaster, and assures affectees that their reactions and behaviour are normal.
Post-disaster crisis counselling has three aims: a) restoring capacity of the individuals; b) reordering and organizing their new world; and c) assisting the victims to deal with the bureaucratic relief emergency program”. If ignored, post-disaster stress can evolve into post-traumatic stress disorder, depression and anxiety syndromes that have long-term negative impact on the suffering individual and their community.
Majority of the care for disaster-affected communities can be provided informally by community-level workers. Such workers should have some counselling experiences, communication skills and sensitivity to the ethnic, social and religious characteristics of the affectees. They also need to have knowledge of local post-disaster plans and work in close collaboration with teams delivering other support to the affectees.
Collaboration with spiritual and religious representatives is very important in helping communities deal with mental trauma caused by the disaster. Cultural-religious rituals play a huge role in providing affected individuals and communities with a sense of closure, especially when facing the loss of life.
Interventions should begin as early as possible, targeting all high-risk populations in the affected area. Notably, the ‘mental health/psychiatric’ label needs to be avoided to encourage participation and avoid stigmatisation.
The list of interventions that can be used to alleviate stress and diffuse mental trauma is very wide and adaptable to a variety of situations. Some of the most accessible interventions include, structuring of daily activities; cultural and religious rituals; and group discussions which validate the emotions caused by the survivor’s experience and survivor’s guilt. Intervention may also include providing factual information and educating parents and teachers. Children can be engaged in various informal education activities (e.g., drawing, sketching, singing, miming, etc. using available community resources). Adult affectees can be engaged in camp activities (cooking, cleaning and assisting in relief work).Additionally, community-based group therapy sessions can utilize group discussions, dramas, storytelling, prayers and sports/games. It is also essential that affectees become involved in re-building their community.
The role of school programs cannot be over-emphasised in the disaster-affected area. By providing children, teachers, parents and administrators with structure and the sense of normalcy, school programs can play a key role in helping disaster affectees to cope with the trauma. School programs serve as effective tools in improving mental health of the children even in those situations where learning activities are very limited and focus on such simple subjects as the importance of sleep and hygiene.
Among the affected groups, particular attention should be paid to children, women (who are typically the primary caregivers in the family) and persons who have lost their homes. Yet another group that requires support in managing the stress and mental trauma are the rescue and relief professionals. Even though these individuals tend to be prepared to face painful experiences, the immense scale of the disaster, as well as fatigue can lead to significant stress and high burnout rates. To minimize the negative effects on their mental health, relief workers should be continuously evaluated before, during and after their deployment. At the end of their deployment, rescue and relief workers should receive debriefing and support in identifying critical incidents in order to put the situation into perspective and reinforce their capacity.
In addition to direct interventions targeting communities affected by disaster and workers involved in rescue and relief efforts, it is important to conduct broader educational-informational activities on the mental health through mass media and awareness campaigns. Interviews with mental health professionals tend to have strong influence over the affectees. Public education should focus on explaining how the population has been psychologically affected by the trauma and the sequences of the stress response to the disaster. Additionally, media should also spread information on the mental health services available in post-disaster situations.
Mental health awareness helps people understand that mental illness is NOT a character flaw but rather an illness like any other. Research shows that when people have better knowledge about different types of mental illness, they are significantly less likely to hold discriminatory views towards those suffering from mental illnesses. Having better knowledge about common disorders will further reduce discriminatory practices, create greater acceptance across communities and lead to people who suffer from mental illness feeling comfortable sharing their stories.
 https://www.who.int/bangladesh/news/detail/25- 07-2016-disasters-and-mental-health